Association Between Chronic Statin Use and 30-Day Mortality in Hospitalized Patients With COVID-19

Abstract

Objective To determine the association between chronic statin use and mortality in patients hospitalized with COVID-19. Patients and Methods We identified a retrospective cohort of patients requiring admission at the Mayo Clinic using our enterprise-wide COVID-19 registry from March 1 st , 2020, through September 30 th , 2020. Available information included age, gender, use of statins, medical comorbidities, and 30-day mortality. We estimated the association of statins with 30-day mortality using odds ratios (OR) and 95% confidence intervals (CI) from logistic regression modeling. Results 1295 patients between the ages of 30 and 80 tested positive for COVID-19 and required admission during the study period, of whom 500 (38.6%) were taking statins at admission. Patients taking statins were older and more likely to have diabetes mellitus or congestive heart failure. Within 30 days of diagnosis, 59 (4.6%) died. In multivariable analysis, statin users did not have statistically different odds of death within 30 days with OR of 1.14 (95% CI: 0.64-2.03, P=.67) compared to non-users. Conclusions Patients with COVID-19 taking statins had similar 30-day mortality to those not taking statins, after adjusting for relevant covariates. Although this is partly influenced by a higher prevalence of risk factors for more severe COVID-19 presentation not entirely adjusted for by the Charlson Comorbidity Index, these data would not support statins as a likely therapeutic intervention for COVID-19 in the hospital setting.

The Association Between the Use of Statins and Clinical Outcomes in Patients with COVID-19: A Systematic Review and Meta-analysis

“…All the included studies [ 11 – 45 ] are observational studies, reported as cohort/case–control studies or database reviews. All except seven studies [ 18 , 26 , 29 , 34 , 35 , 38 , 39 ] were based directly on the hospital (or nursing home) medical records, and 12 of the included studies [ 13 , 20 , 22 , 23 , 25 , 31 , 33 , 36 , 41 – 44 ] are single-centered observational studies. These hospital- (or nursing home)-based studies [ 11 – 17 , 19 – 25 , 27 , 28 , 30 – 34 , 36 , 37 , 40 – 45 ] covered a moderate number of participants per study (median 840.0, interquartile range 286.5–1997.5).…”

“…All except seven studies [ 18 , 26 , 29 , 34 , 35 , 38 , 39 ] were based directly on the hospital (or nursing home) medical records, and 12 of the included studies [ 13 , 20 , 22 , 23 , 25 , 31 , 33 , 36 , 41 – 44 ] are single-centered observational studies. These hospital- (or nursing home)-based studies [ 11 – 17 , 19 – 25 , 27 , 28 , 30 – 34 , 36 , 37 , 40 – 45 ] covered a moderate number of participants per study (median 840.0, interquartile range 286.5–1997.5). The remaining seven studies [ 18 , 26 , 29 , 34 , 35 , 38 , 39 ] analyzed data from the nation-level registries (retrospective database reviews), and included a range of 1868–64,781 participants.…”

“…These hospital- (or nursing home)-based studies [ 11 – 17 , 19 – 25 , 27 , 28 , 30 – 34 , 36 , 37 , 40 – 45 ] covered a moderate number of participants per study (median 840.0, interquartile range 286.5–1997.5). The remaining seven studies [ 18 , 26 , 29 , 34 , 35 , 38 , 39 ] analyzed data from the nation-level registries (retrospective database reviews), and included a range of 1868–64,781 participants. The regions where the included studies were performed span Asia (China [ n = 4] [ 11 , 12 , 27 , 42 ], Iran [ n = 1] [ 31 ], and Korea [ n = 1] [ 39 ]), Europe (Italy [ n = 4] [ 14 , 23 , 28 , 37 ], the United Kingdom [ n = 2] [ 25 , 30 ], Belgium [ n = 1] [ 15 ], France [ n = 1] [ 19 ], Spain [ n = 3] [ 24 , 35 , 40 ], Denmark [ n = 1] [ 26 ], Poland [ n = 1] [ 44 ], Sweden [ n = 1] [ 38 ], and Belgium [ n = 1] [ 32 ]), and North America (the United States of America [ n = 14] [ 13 , 16 – 18 , 20 – 22 , 29 , 33 , 34 , 36 , 41 , 43 , 45 ]).…”

“…The remaining seven studies [ 18 , 26 , 29 , 34 , 35 , 38 , 39 ] analyzed data from the nation-level registries (retrospective database reviews), and included a range of 1868–64,781 participants. The regions where the included studies were performed span Asia (China [ n = 4] [ 11 , 12 , 27 , 42 ], Iran [ n = 1] [ 31 ], and Korea [ n = 1] [ 39 ]), Europe (Italy [ n = 4] [ 14 , 23 , 28 , 37 ], the United Kingdom [ n = 2] [ 25 , 30 ], Belgium [ n = 1] [ 15 ], France [ n = 1] [ 19 ], Spain [ n = 3] [ 24 , 35 , 40 ], Denmark [ n = 1] [ 26 ], Poland [ n = 1] [ 44 ], Sweden [ n = 1] [ 38 ], and Belgium [ n = 1] [ 32 ]), and North America (the United States of America [ n = 14] [ 13 , 16 – 18 , 20 – 22 , 29 , 33 , 34 , 36 , 41 , 43 , 45 ]). Seven studies [ 15 , 19 , 32 – 34 , 38 , 42 ] (could have) included both laboratory-confirmed and clinically or radiologically confirmed patients with COVID-19, while the remaining studies [ 11 – 14 , 16 – 18 , 20 – 31 , 33 – 37 , 39 – 41 ,…”

“…Subgroup analyses with studies originating from Asia (HR = 0.56; 95% CI 0.42–0.75) [ 12 , 27 , 31 ], Europe (OR = 0.77; 95% CI 0.64–0.94) [ 19 , 23 , 25 , 28 , 30 , 32 , 35 , 37 , 38 , 40 , 44 ], and North America (OR = 0.62; 95% CI 0.54–0.73), respectively [ 16 – 18 , 21 , 29 , 33 , 34 , 41 , 43 ], observed significantly reduced risks of mortality with the use of statins in patients with COVID-19 compared to non-use of statins. Findings from the sensitivity analyses with studies [ 12 – 14 , 16 – 18 , 20 , 21 , 23 – 31 , 35 – 37 , 39 – 41 , 43 – 45 ] including only laboratory-confirmed patients with COVID-19 (OR = 0.67; 95% CI 0.56–0.79 and HR = 0.70; 95% CI 0.58–0.84) and studies [ 12 , 13 , 20 , 27 , 32 , 35 , 36 , 39 , 42 , 44 ] that confirmed the continuation of statins during hospitalization for COVID-19 (OR = 0.61; 95% CI 0.52–0.73 and HR = 0.59; 95% CI 0.41–0.84), are consistent with the main analyses.…”